Paper
Saturday, 22 July 2006
This presentation is part of : Strategies in Critical Care
Reducing Urinary Tract Infections in an ICU: Changing Practice Through Evidence and Research
Laura Reilly, RN, BSN, CCRN1, Patricia Sullivan, RN, CIC2, Denise Fochesto, RN, MSN, CCRN, APN-C1, Sharon Ninni, RN, BSN, CCRN1, and Brandee Fetherman, RN, BSN, CCRN1. (1) Intensive Care Unit, Morristown Memorial Hospital, Morristown, NJ, USA, (2) Infection Control, Morristown Memorial Hospital, Morristown, NJ, USA
Learning Objective #1: describe an evidence-based quality improvement project that developed into a nursing research project.
Learning Objective #2: describe how an educational program, algorithm, and criteria-based guidelines, has led to a change in nursing practice and a reduction in UTIs in an ICU.
Problem: Urinary-tract-infections (UTIs) are a common complication in the critical care patient population. The prolonged use of indwelling urinary catheters can further increase that risk.
Rationale: Reducing the average length-of-time indwelling urinary catheters are maintained in this patient population will reduce UTIs.
Methods:
This evidence-based quality improvement project focused on reducing the average amount of time, in days, that indwelling urinary catheters remained intact and was submitted through our organizations Six Sigma Department. Once the root causes were analyzed and the improvement plan was identified, it was decided to evaluate the effectiveness of the project through research. After further review of the literature and several brainstorming sessions with staff criteria-based guidelines, an algorithm, and an educational in-service was developed. A checklist was utilized by nurses to evaluate the patients daily. If they did not meet the unit-based criteria indicating acceptable reasons for the catheter, the physician was notified for an order to remove it. The research design included a quasi-experimental randomized protocol with a historical control. A retrospective 124 chart randomized sample was used for baseline data. The charts were reviewed manually and the average indwelling urinary catheter days were calculated. The pre-intervention data showed the average length-of-time for indwelling urinary catheters to be 4.17 days and the standard deviation 6.7 (n=124, 95% confident sample).
Results: Post-intervention, mean catheter days = 2.98 (n = 83). A 2-sample t-test determined a statistical significant change in the means (p=.03).
The post-intervention standard deviation was 3.17 (n = 83). A Test for Equal Variances determined a change in standard deviations with 94% confidence (p=.06).  This units UTI rate has decreased by 33% one-year post intervention.
Conclusion:
Criteria-based guidelines can be utilized to reduce the use of unnecessary indwelling urinary catheters to reduce UTIs.

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See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)